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Can the Interferon package be used in conjunction with the IL-2 without causing problems or invalidating the trial?
Dear Dr. Chung,
I'm co-infected, have been HIV+ for 17 years that I know of and HCV+ for at least 12. Seven or eight years ago my HCV was treated with Interferon Alpha for a time, I don't remember how long, and the enzyme levels returned to normal levels. Since that time I started taking ARV's for the HIV with great success. My HIV viral load is now and has been for years <50. Fourteen months ago a month after my third session of IL-2 my CD-4 count was 3101. Three weeks ago it was down to 1089; I'm supposed to have more of the IL-2 when it gets to below 1000, and at this rate that will probably be in a couple of months. I've got a couple of questions. The only ARV's that I've taken in all this time are D4T and 3TC, and they are obviously still working well. Also obviously, the IL-2 is doing wonders. Just for reference, before I started the IL-2 - as a part of the Esprit trial - my CD-4 count had been stable in the 800 range for about four of the five years that I had been taking the ARV's. I have also been told that my liver enzymes are rising again and it's been predicted that I'll have to go on the Interferon/Ribavirin routine soon - I'll have to confess that I don't know what the HCV viral load is right now. My questions are thus: Can the Interferon package be used in conjunction with the IL-2 without causing problems or invalidating the trial? Also, I read somewhere on the internet recently, though I can't remember where, that Ribavirin has been shown to reduce the levels of 3TC in the blood, and that increasing the dosage of the 3TC to bring the levels back to normal wipes out the effect of the Ribavirin.
Since the Interferon worked successfully by itself last time, would it be appropriate to use it that way again? The HIV ARVs' have been working so well that I'd hate to do anything that would bring on resistance. Is this a catch 22, or is there a practical way out?
All this is being done at the VA here in Atlanta. I don't know about the HEP C people having not really met them yet, but the consulting doctors in the ID clinic are from the CDC. I would still appreciate your comments, though, as second opinions are always valued. Thanks for your time.
  Dr Chung Writes-  
You should not have a problem adding IFN and RBV to the IL-2, although you'll have to clear that with the Esprit trial group. in fact, a pilot study ACTG 5088 is looking at PEGIFN + RBV + IL-2. The ribavirin should not adversely affect 3TC - it can decrease effective levels of d4T, but this has not thus far been shown to be problematic as far as HIV control is concerned.
editorial note from Jules Levin: I'm not sure whether it matters if a person has 800, 1000, or 2000 CD4s. The side effects & toxicities associated with IFN/RBV can be difficult. adding IL-2 may make it much more difficult.
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